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Akinetic versus dyskinetic left ventricular aneurysms diagnosed by gated scintigraphy: difference in surgical outcome

A Mangschau1

  • 1Medical Department B, Rikshospitalet, University of Oslo, Norway.

The Annals of Thoracic Surgery
|May 1, 1989
PubMed

Insights

Left ventricular aneurysm resection surgery improved outcomes for patients with paradoxical systolic expansion. Patients with akinetic aneurysms showed no change, indicating dyskinesia predicts favorable surgical results.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Left ventricular aneurysms (LVAs) are a complication of myocardial infarction.
  • Surgical intervention, including aneurysm resection and coronary artery bypass grafting (CABG), is considered for specific LVA cases.
  • The impact of aneurysm wall motion on surgical outcomes remains an area of investigation.

Purpose of the Study:

  • To determine if paradoxical systolic expansion of left ventricular aneurysms influences surgical outcomes.
  • To evaluate the efficacy of left ventricular aneurysm resection and CABG in patients with different types of aneurysms.

Main Methods:

  • Forty-one patients undergoing LVA resection and CABG were assessed.
  • Pre- and post-operative evaluations included gated radionuclide ventriculography and right heart catheterization.
  • Patients were categorized based on aneurysm wall motion: paradoxical systolic expansion (dyskinesia) or akinetic.

Main Results:

  • Patients with paradoxical LVAs showed significant improvement in New York Heart Association functional classification (p<0.01) and exercise tolerance (p<0.001).
  • Left ventricular ejection fraction improved significantly (p<0.001 at rest, p<0.0001 with exercise) with reduced end-diastolic (p<0.002) and end-systolic volumes (p<0.001) in the paradoxical group.
  • Patients with akinetic aneurysms experienced no significant changes in these parameters.
  • Multivariate analysis identified aneurysm dyskinesia as the sole independent predictor of favorable surgical outcome (p<0.004).

Conclusions:

  • The presence of dyskinesia in left ventricular aneurysms is a significant predictor of positive outcomes following surgical resection and CABG.
  • Radionuclide ventriculography is valuable in assessing aneurysm wall motion and guiding surgical decisions.
  • Surgical intervention for LVAs with paradoxical motion leads to functional and hemodynamic improvements.

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